Skin infections in pregnancy.

A wide array of infectious diseases can occur in pregnancy. Their acquisition, clinical presentation, and course during gestation may be altered due to an impairment of the maternal cellular immunity. Some infectious diseases can lead to serious consequences for the mother or the offspring, including congenital malformations. This review describes in detail the clinical presentation, course, management, and associated maternal and fetal risks of selected viral (varicella-zoster virus infections, condylomata acuminata), fungal (candida vulvovaginitis), bacterial (Lyme borreliosis), and parasitic (scabies) infections. The treatment options are critically reviewed. First-line therapies include acyclovir and varicella-zoster virus immunoglobulin for varicella-zoster virus infections, surgical modalities for genital warts, topical clotrimazole and oral fluconazole for Candida vulvovaginitis, amoxicillin and cefuroxime for Lyme borreliosis, and permethrin for scabies. A synopsis of maternal and fetal risks of other important infections is also included.

Australian Paediatric Surveillance Unit annual report, 2013.

This report provides an update on the surveillance conducted by the Australian Paediatric Surveillance Unit (APSU) during the period January to December 2013. The APSU facilitates national active surveillance of uncommon diseases of childhood including selected communicable diseases. This report includes data on the following conditions: acute flaccid paralysis (AFP), congenital cytomegalovirus (cCMV), congenital rubella, perinatal exposure to HIV and paediatric HIV infection, neonatal herpes simplex virus (HSV), congenital varicella, neonatal varicella, severe complications of varicella and juvenile onset recurrent respiratory papillomatosis (JoRRP). Surveillance of severe complications of influenza was undertaken during the influenza season (July to September 2013).

Varicella-zoster virus: Prevention through vaccination.

Widespread use of varicella vaccine in the United States has drastically changed the epidemiology of the disease. Although chickenpox is no longer a ubiquitous childhood infection, varicella-zoster virus continues to circulate in the community and nonimmune pregnant women remain at risk. Varicella can cause severe infection in pregnant women, often complicated by viral pneumonia. Maternal varicella occurring in the first half of pregnancy can cause the rare but devastating congenital varicella syndrome, whereas infection in the late stages of pregnancy may cause neonatal varicella. The best approach to avoiding the morbidity and mortality associated with chickenpox in pregnancy is to screen and vaccinate susceptible reproductive-age women.

Congenital varicella syndrome in a very low birthweight preterm infant.

Congenital varicella syndrome (CVS) is a rare but deleterious consequence of primary varicella zoster virus (VZV) infection during pregnancy. Typical CVS stigmata are cerebral abnormalities, eye diseases and segmentally distributed, cicatricial skin lesions. In this paper the authors report on a male preterm infant, born at 30 weeks of gestation, who developed pustular skin lesions at the age of 4 weeks. The mother had suffered from chickenpox at 14 weeks of gestation. Apart from skin manifestations, critical bronchopulmonary dysplasia made the infant conspicuous. The VZV genome was detected in blood, respiratory secretions and skin lesions. At age 10 weeks he presented with extensive intestinal wall perforation, considered to be related to CVS, which finally led to death. This case shows for the first time the clinical course of CVS in a preterm infant. It illustrates the need for discussion of comprehensive VZV vaccination for seronegative women of childbearing age.

Prenatal ultrasound diagnosis, follow-up, and outcome of congenital varicella syndrome.

OBJECTIVES: To report on a case of fetal varicella infection following the diagnosis of maternal infection at 16 weeks of gestation. METHODS: Diagnosis was based on serology testing and prenatal ultrasound, confirmed by DNA detection in amniotic fluid (Lightcycler-PCR). Serial ultrasound examinations were performed. RESULTS: Sonographic anomalies included borderline ventriculomegaly, intracerebral, intrahepatic and myocardial calcifications, limb deformities, articular effusions, and intrauterine growth retardation (confirmed postpartally). The newborn showed a severe encephalopathy and could not be stabilized sufficiently. The child died 23 days after birth. CONCLUSION: The outcome of an affected fetus may be very serious and prenatal ultrasound is a helpful tool to recognize the severity of the infection.

Congenital varicella-zoster virus infection. A rare case of severe brain and ocular malformations without limb or cutaneous involvement in a newborn after maternal subclinical infection.

Although congenital varicella-zoster virus VZV infection is rare, it carries serious morbidity and mortality to the fetus and newborn infant. We report a full term female newborn infant, born to a multipara unbooked mother who had VZV subclinical infection during the first trimester of pregnancy. Routine newborn examination showed cystic malformation of the left eye, and absence of the right eye globe. Radiological work up revealed severe brain and eye malformations, serological studies of both mother and baby were positive for VZV. The baby underwent palliative surgery to the eyes, upon discharge, a plan of multidisciplinary team was made for follow up including neurologist, ophthalmologist, pediatrician and social worker. Congenital VZV infection can be severe enough to cause catastrophic fetal anomalies and damage to the vital organs as many of those infants die in infancy.

[Congenital varicella: limits of prenatal diagnosis]. / La varicelle congénitale: les limites du diagnostic prénatal.

INTRODUCTION: Primary varicella infection during pregnancy is uncommon. Fetal varicella syndrome is unusual when varicella occurs after 20 weeks of gestation. CASE REPORT: A mother contracted chicken pox at 21 weeks and 3 days of gestation. Monthly monitoring was assured by the center for prenatal diagnosis, starting from 23 weeks. At 36 weeks, foetal echography detected liver calcifications, without other lesions. At 38 weeks, the patient went into spontaneous labour and delivered a male baby. The baby presented cicatricial skin lesions all over the body and scalp. The cerebral scan detected calcifications and a bilateral chorioretinitis was noticed. At 12 months, the infant had delayed psychomotor acquisitions, a cerebral cortical atrophy and blindness. CONCLUSION: The presence of fetal liver calcifications after chicken pox in the mother is a seldom reported sign. In our observation, liver calcifications were the single sign of a severe fetal damage.

Ipsilateral renal dysplasia with hypertensive heart disease in an infant with cutaneous varicella lesions: an unusual presentation of congenital varicella syndrome.

A child with congenital varicella syndrome including cutaneous lesions and ipsilateral renal dysplasia with hypertensive heart disease is described. Varicella was contracted during the tenth week of gestation. Typical congenital varicella bullae, high titer of anti-varicella-zoster virus IgM, and a small right kidney were noted after birth. Hypertensive heart disease resulting from renal dysplasia occurred at 1 year of age. The cutaneous lesions and the dysplastic kidney involved the same dermatomes. Nephrectomy proved to be the treatment of choice for hypertension and congestive heart failure.

[Abnormal fetal ultrasound findings after maternal chickenpox infection]. / Abnorme UL-fund hos fosteret efter maternel skoldkoppeinfektion.

Chicken pox infection in the first and early in the second trimester can lead to intrauterine infection and a 2% risk of developing congenital varicella syndrome (CVS). CVS is characterized by one or more of the following malformations: hypoplasia of a limb, scarring of the skin, microcephaly, cataract, microophthalmia, cerebellar dysplasia, gastrointestinal malformations and urogenital malformations. Most of these malformations can be seen by ultrasound. Foetal viral infection can also lead to intrauterine growth retardation, polyhydramnios and hydrops foetalis. This paper is a review of the literature with the focus on ultrasound findings in CVS. The options for performing prenatal diagnostic tests and the consequences of maternal varicella zoster (chickenpox) for prenatal care are discussed.

[Congenital Langerhans-cell histiocytosis presenting as a varicella infection]. / Kongenitale Langerhans-Zellen-Histiozytose unter dem klinischen Bild einer Varizelleninfektion.

UNLABELLED: We report on a preterm infant (33rd gestational week) with a varicella-like congenital rash, which initially appeared to respond to therapy with acyclovir. At the age of 3 weeks, lesions were in different stages of evolution and still resembled a varicella zoster virus (VZV) infection. However, since proof of VZV infection was lacking and new lesions erupted at the age of 4 weeks, a skin biopsy was performed which revealed a diagnosis of Langerhans cells histiocytosis. Therapy with prednisone resulted in prompt healing of the lesions. DISCUSSION: Congenital Langerhans cell histiocytosis is rare and symptoms may vary substantially from case to case. Like in our observation it may be confused with congenital varicella. In case of congenital skin lesions of uncertain etiology a skin biopsy should be performed.

Síndrome da angústia respiratória aguda em um recém-nascido com varicela perinatal congênita / Acute respiratory distress syndrome in a newborn with congenital chickenpox

Um recém-nascido com varicela perinatal congênita, complicada por pneumonia e pulmpo de choque, foi admitido em nosso hospital com 14 dias de vida em insuficiência respiratória grave. O recém-nascido näo recebeu imunoglobulina específica para o vírus varicela-zoster. A mäe apresentou exantema característico de varicela três dias antes do parto. Com nove dias de vida o recém-nascido iniciou a sintomatologia com vesículas, evoluindo com aumento progressivo das lesöes de pele, febre, dificuldade para sugar e respirar e cianose progressiva. O raio X de tórax inicialmente revelava infiltrado pulmonar reticular difuso, progredindo rapidamente para imagem de reduçäo acentuada da transparência pulmonar, bilateralmente, com broncogramas aéreos difusos, compatível com pulmpo de choque. Foi iniciada ventilaçäo assistida convencional, associada a quimioterapia antiviral com aciclovir. Concomitante ao quadro pulmonar apresentou hepatite, meningoencefalite e CIVD. Permaneceu em ventilaçäo pulmonar mecânica por nove dias. Recebeu alta hospitalar após 21 dias de internaçäo, com idade de um mês e cinco dias de vida, sem doenta pulmonar crônica, sem dependência de oxigênio. Atualmente com dois anos de idade, sem seqnela pulmonar e/ou neurológica.

Evaluación neurológica de niños con exposición intrauterina a varicela durante las primeras 20 semanas de gestación / Neurologic outcome of children with intrauterine expositure to varicella infection during the firs 200 weeks of gestation

Introducción: la asociación de varicela con el embarazo es infrecuente, sin embargo, existe el riesgo de infección vertical. Los casos de varicela materna que se producen durante el primero o segundo trimestres de la gestación ocasionalmente se asocian al desarrollo del síndrome de varicela congénita, el cual incluye manifestaciones neurológicas, dermatológicas, oculares y esqueléticas. Objetivo: evaluar el desarrollo psicomotor de niños con exposición in útero al virus Varicela-Zoster durante las primeras 20 semanas de gestación. Material y método. Se estudiaron 22 embarazadas con varicela dentro de las primeras 20 semanas. Se etableció seguimiento postnatal a los productos para evaluar su desarrollo psicomotor. La evaluación se realizó mediante las pruebas de Amiel-Tison en los niños menores de un año y Denver II modificado en los mayores de un año. Resultados. Ninguna de las madres presentó complicaciones secundarias a la varicela. Hubo dos partos pretérmino. Ninguno de los productos nació malformado, hubo un niño con microcefalia y otro con bajo peso para la edad gestacional. Se tuvo seguimiento de 14 niños, la mediana de edad al momento de la evaluación neurológica fue de 13 meses con un intervalo de tres a 44 meses. Trece de los niños han tenido un desarrollo psicomotor normal, un niño de 44 meses, presenta retraso en el lenguaje, sin embargo tiene otros antecedentes de riesgo para daño neurológico, como prematurez y asfixia neonatal. Conclusiones: la varicela que ocurre dentro de las primeras 20 semanas de la gestación tiene un riesgo bajo de afectar el curso del embarazo y de dañar a los productos

Congenital varicella of the upper limb. A preventable disaster.

Two patients with a rare form of congenital varicella involving the upper limb are described. The spectrum of disease, pathophysiology, principles of management and prevention are discussed.